Serotype-Specific Changes in Invasive Pneumococcal Disease after Pneumococcal Conjugate Vaccine Introduction: A Pooled Analysis of Multiple Surveillance Sites

Daniel R. Feikin; Eunice W. Kagucia; Jennifer D. Loo; Ruth Link-Gelles; Milo A. Puhan; Thomas Cherian; Orin S. Levine; Cynthia G. Whitney; Katherine L. O'Brien; Matthew R. Moore; Daniel R. Feikin; Ruth Link-Gelles; Thomas Cherian; Richard A. Adegbola; Mary Agocs; Krow Ampofo; Nick Andrews; Theresa Barton; Javier Benito; Claire V. Broome; Michael G. Bruce; Lisa R. Bulkow; Carrie L. Byington; Teresa Camou; Heather Cook; Suzanne Cotter; Ron Dagan; Philippe de Wals; Geneviève Deceuninck; Barbara Denham; Giles Edwards; Juhani Eskola; Margaret Fitzgerald; Emmanouil Galanakis; Gabriela Garcia-Gabarrot; Juan J. Garcia-Garcia; Amadeu Gene; Borja Gomez; Helen Heffernan; Thomas W. Hennessy; Sigrid Heuberger; Markus Hilty; Helene Ingels; Sanjay Jayasinghe; Eunice W. Kagucia; James D. Kellner; Nicola P. Klein; Andrea Kormann-Klement; Jana Kozakova; Vicki Krause; Paula Kriz; Lotte Lambertsen; Agnès Lepoutre; Orin S. Levine; Marc Lipsitch; Jennifer D. Loo; Mariana Lopez-Vega; Marguerite Lovgren; Sofia Maraki; Edward O. Mason; Peter B. McIntyre; Robert Menzies; Allison Messina; Elizabeth Miller; Santiago Mintegi; Matthew R. Moore; Jitka Motlova; Lawrence H. Moulton; Kathrin Mühlemann; Carmen Muñoz-Almagro; Katherine L. O'Brien; David R. Murdoch; Daniel E. Park; Milo A. Puhan; Arthur L. Reingold; Raquel Sa-Leao; Abanti Sanyal; Peter G. Smith; Lodewijk Spanjaard; Chonnamet Techasaensiri; Richard E. Thompson; Koh C. Thoon; Gregory J. Tyrrell; Palle Valentiner-Branth; Arie van der Ende; Otto G. Vanderkooi; Mark P.G. van der Linden; Emmanuelle Varon; Jan Verhaegen; Didrik F. Vestrheim; Imelda Vickers; Anne von Gottberg; Rüdiger von Kries; Pauline Waight; Robert Weatherholtz; Susanne Weiss; Cynthia G. Whitney; Arnold Yee; Anita K.M. Zaidi

doi:10.1371/journal.pmed.1001517

Serotype-Specific Changes in Invasive Pneumococcal Disease after Pneumococcal Conjugate Vaccine Introduction: A Pooled Analysis of Multiple Surveillance Sites

Daniel R. Feikin, Eunice W. Kagucia, Jennifer D. Loo, Ruth Link-Gelles, Milo A. Puhan, Thomas Cherian, Orin S. Levine, Cynthia G. Whitney, Katherine L. O'Brien, Matthew R. Moore, Daniel R. Feikin, Ruth Link-Gelles, Thomas Cherian, Richard A. Adegbola, Mary Agocs, Krow Ampofo, Nick Andrews, Theresa Barton, Javier Benito, Claire V. BroomeMichael G. Bruce, Lisa R. Bulkow, Carrie L. Byington, Teresa Camou, Heather Cook, Suzanne Cotter, Ron Dagan, Philippe de Wals, Geneviève Deceuninck, Barbara Denham, Giles Edwards, Juhani Eskola, Margaret Fitzgerald, Emmanouil Galanakis, Gabriela Garcia-Gabarrot, Juan J. Garcia-Garcia, Amadeu Gene, Borja Gomez, Helen Heffernan, Thomas W. Hennessy, Sigrid Heuberger, Markus Hilty, Helene Ingels, Sanjay Jayasinghe, Eunice W. Kagucia, James D. Kellner, Nicola P. Klein, Andrea Kormann-Klement, Jana Kozakova, Vicki Krause, Paula Kriz, Lotte Lambertsen, Agnès Lepoutre, Orin S. Levine, Marc Lipsitch, Jennifer D. Loo, Mariana Lopez-Vega, Marguerite Lovgren, Sofia Maraki, Edward O. Mason, Peter B. McIntyre, Robert Menzies, Allison Messina, Elizabeth Miller, Santiago Mintegi, Matthew R. Moore, Jitka Motlova, Lawrence H. Moulton, Kathrin Mühlemann, Carmen Muñoz-Almagro, Katherine L. O'Brien, David R. Murdoch, Daniel E. Park, Milo A. Puhan, Arthur L. Reingold, Raquel Sa-Leao, Abanti Sanyal, Peter G. Smith, Lodewijk Spanjaard, Chonnamet Techasaensiri, Richard E. Thompson, Koh C. Thoon, Gregory J. Tyrrell, Palle Valentiner-Branth, Arie van der Ende, Otto G. Vanderkooi, Mark P.G. van der Linden, Emmanuelle Varon, Jan Verhaegen, Didrik F. Vestrheim, Imelda Vickers, Anne von Gottberg, Rüdiger von Kries, Pauline Waight, Robert Weatherholtz, Susanne Weiss, Cynthia G. Whitney, Arnold Yee, Anita K.M. Zaidi

Bloomberg School of Public Health

Research output: Contribution to journal › Article › peer-review

305 Scopus citations

Abstract

Background:Vaccine-serotype (VT) invasive pneumococcal disease (IPD) rates declined substantially following introduction of 7-valent pneumococcal conjugate vaccine (PCV7) into national immunization programs. Increases in non-vaccine-serotype (NVT) IPD rates occurred in some sites, presumably representing serotype replacement. We used a standardized approach to describe serotype-specific IPD changes among multiple sites after PCV7 introduction.Methods and Findings:Of 32 IPD surveillance datasets received, we identified 21 eligible databases with rate data ≥2 years before and ≥1 year after PCV7 introduction. Expected annual rates of IPD absent PCV7 introduction were estimated by extrapolation using either Poisson regression modeling of pre-PCV7 rates or averaging pre-PCV7 rates. To estimate whether changes in rates had occurred following PCV7 introduction, we calculated site specific rate ratios by dividing observed by expected IPD rates for each post-PCV7 year. We calculated summary rate ratios (RRs) using random effects meta-analysis. For children <5 years old, overall IPD decreased by year 1 post-PCV7 (RR 0·55, 95% CI 0·46-0·65) and remained relatively stable through year 7 (RR 0·49, 95% CI 0·35-0·68). Point estimates for VT IPD decreased annually through year 7 (RR 0·03, 95% CI 0·01-0·10), while NVT IPD increased (year 7 RR 2·81, 95% CI 2·12-3·71). Among adults, decreases in overall IPD also occurred but were smaller and more variable by site than among children. At year 7 after introduction, significant reductions were observed (18-49 year-olds [RR 0·52, 95% CI 0·29-0·91], 50-64 year-olds [RR 0·84, 95% CI 0·77-0·93], and ≥65 year-olds [RR 0·74, 95% CI 0·58-0·95]).Conclusions:Consistent and significant decreases in both overall and VT IPD in children occurred quickly and were sustained for 7 years after PCV7 introduction, supporting use of PCVs. Increases in NVT IPD occurred in most sites, with variable magnitude. These findings may not represent the experience in low-income countries or the effects after introduction of higher valency PCVs. High-quality, population-based surveillance of serotype-specific IPD rates is needed to monitor vaccine impact as more countries, including low-income countries, introduce PCVs and as higher valency PCVs are used.Please see later in the article for the Editors' Summary.

Original language	English (US)
Article number	e1001517
Journal	PLoS medicine
Volume	10
Issue number	9
DOIs	https://doi.org/10.1371/journal.pmed.1001517
State	Published - Sep 2013

ASJC Scopus subject areas

General Medicine

Access to Document

10.1371/journal.pmed.1001517

Cite this

Feikin, D. R., Kagucia, E. W., Loo, J. D., Link-Gelles, R., Puhan, M. A., Cherian, T., Levine, O. S., Whitney, C. G., O'Brien, K. L., Moore, M. R., Feikin, D. R., Link-Gelles, R., Cherian, T., Adegbola, R. A., Agocs, M., Ampofo, K., Andrews, N., Barton, T., Benito, J., ... Zaidi, A. K. M. (2013). Serotype-Specific Changes in Invasive Pneumococcal Disease after Pneumococcal Conjugate Vaccine Introduction: A Pooled Analysis of Multiple Surveillance Sites. PLoS medicine, 10(9), Article e1001517. https://doi.org/10.1371/journal.pmed.1001517

Feikin, DR, Kagucia, EW, Loo, JD, Link-Gelles, R, Puhan, MA, Cherian, T, Levine, OS, Whitney, CG, O'Brien, KL, Moore, MR, Feikin, DR, Link-Gelles, R, Cherian, T, Adegbola, RA, Agocs, M, Ampofo, K, Andrews, N, Barton, T, Benito, J, Broome, CV, Bruce, MG, Bulkow, LR, Byington, CL, Camou, T, Cook, H, Cotter, S, Dagan, R, de Wals, P, Deceuninck, G, Denham, B, Edwards, G, Eskola, J, Fitzgerald, M, Galanakis, E, Garcia-Gabarrot, G, Garcia-Garcia, JJ, Gene, A, Gomez, B, Heffernan, H, Hennessy, TW, Heuberger, S, Hilty, M, Ingels, H, Jayasinghe, S, Kagucia, EW, Kellner, JD, Klein, NP, Kormann-Klement, A, Kozakova, J, Krause, V, Kriz, P, Lambertsen, L, Lepoutre, A, Levine, OS, Lipsitch, M, Loo, JD, Lopez-Vega, M, Lovgren, M, Maraki, S, Mason, EO, McIntyre, PB, Menzies, R, Messina, A, Miller, E, Mintegi, S, Moore, MR, Motlova, J, Moulton, LH, Mühlemann, K, Muñoz-Almagro, C, O'Brien, KL, Murdoch, DR, Park, DE, Puhan, MA, Reingold, AL, Sa-Leao, R, Sanyal, A, Smith, PG, Spanjaard, L, Techasaensiri, C, Thompson, RE, Thoon, KC, Tyrrell, GJ, Valentiner-Branth, P, van der Ende, A, Vanderkooi, OG, van der Linden, MPG, Varon, E, Verhaegen, J, Vestrheim, DF, Vickers, I, von Gottberg, A, von Kries, R, Waight, P, Weatherholtz, R, Weiss, S, Whitney, CG, Yee, A & Zaidi, AKM 2013, 'Serotype-Specific Changes in Invasive Pneumococcal Disease after Pneumococcal Conjugate Vaccine Introduction: A Pooled Analysis of Multiple Surveillance Sites', PLoS medicine, vol. 10, no. 9, e1001517. https://doi.org/10.1371/journal.pmed.1001517

@article{e810a0a3283f47c79bcaee3112ff503a,

title = "Serotype-Specific Changes in Invasive Pneumococcal Disease after Pneumococcal Conjugate Vaccine Introduction: A Pooled Analysis of Multiple Surveillance Sites",

abstract = "Background:Vaccine-serotype (VT) invasive pneumococcal disease (IPD) rates declined substantially following introduction of 7-valent pneumococcal conjugate vaccine (PCV7) into national immunization programs. Increases in non-vaccine-serotype (NVT) IPD rates occurred in some sites, presumably representing serotype replacement. We used a standardized approach to describe serotype-specific IPD changes among multiple sites after PCV7 introduction.Methods and Findings:Of 32 IPD surveillance datasets received, we identified 21 eligible databases with rate data ≥2 years before and ≥1 year after PCV7 introduction. Expected annual rates of IPD absent PCV7 introduction were estimated by extrapolation using either Poisson regression modeling of pre-PCV7 rates or averaging pre-PCV7 rates. To estimate whether changes in rates had occurred following PCV7 introduction, we calculated site specific rate ratios by dividing observed by expected IPD rates for each post-PCV7 year. We calculated summary rate ratios (RRs) using random effects meta-analysis. For children <5 years old, overall IPD decreased by year 1 post-PCV7 (RR 0·55, 95% CI 0·46-0·65) and remained relatively stable through year 7 (RR 0·49, 95% CI 0·35-0·68). Point estimates for VT IPD decreased annually through year 7 (RR 0·03, 95% CI 0·01-0·10), while NVT IPD increased (year 7 RR 2·81, 95% CI 2·12-3·71). Among adults, decreases in overall IPD also occurred but were smaller and more variable by site than among children. At year 7 after introduction, significant reductions were observed (18-49 year-olds [RR 0·52, 95% CI 0·29-0·91], 50-64 year-olds [RR 0·84, 95% CI 0·77-0·93], and ≥65 year-olds [RR 0·74, 95% CI 0·58-0·95]).Conclusions:Consistent and significant decreases in both overall and VT IPD in children occurred quickly and were sustained for 7 years after PCV7 introduction, supporting use of PCVs. Increases in NVT IPD occurred in most sites, with variable magnitude. These findings may not represent the experience in low-income countries or the effects after introduction of higher valency PCVs. High-quality, population-based surveillance of serotype-specific IPD rates is needed to monitor vaccine impact as more countries, including low-income countries, introduce PCVs and as higher valency PCVs are used.Please see later in the article for the Editors' Summary.",

author = "Feikin, {Daniel R.} and Kagucia, {Eunice W.} and Loo, {Jennifer D.} and Ruth Link-Gelles and Puhan, {Milo A.} and Thomas Cherian and Levine, {Orin S.} and Whitney, {Cynthia G.} and O'Brien, {Katherine L.} and Moore, {Matthew R.} and Feikin, {Daniel R.} and Ruth Link-Gelles and Thomas Cherian and Adegbola, {Richard A.} and Mary Agocs and Krow Ampofo and Nick Andrews and Theresa Barton and Javier Benito and Broome, {Claire V.} and Bruce, {Michael G.} and Bulkow, {Lisa R.} and Byington, {Carrie L.} and Teresa Camou and Heather Cook and Suzanne Cotter and Ron Dagan and {de Wals}, Philippe and Genevi{\`e}ve Deceuninck and Barbara Denham and Giles Edwards and Juhani Eskola and Margaret Fitzgerald and Emmanouil Galanakis and Gabriela Garcia-Gabarrot and Garcia-Garcia, {Juan J.} and Amadeu Gene and Borja Gomez and Helen Heffernan and Hennessy, {Thomas W.} and Sigrid Heuberger and Markus Hilty and Helene Ingels and Sanjay Jayasinghe and Kagucia, {Eunice W.} and Kellner, {James D.} and Klein, {Nicola P.} and Andrea Kormann-Klement and Jana Kozakova and Vicki Krause and Paula Kriz and Lotte Lambertsen and Agn{\`e}s Lepoutre and Levine, {Orin S.} and Marc Lipsitch and Loo, {Jennifer D.} and Mariana Lopez-Vega and Marguerite Lovgren and Sofia Maraki and Mason, {Edward O.} and McIntyre, {Peter B.} and Robert Menzies and Allison Messina and Elizabeth Miller and Santiago Mintegi and Moore, {Matthew R.} and Jitka Motlova and Moulton, {Lawrence H.} and Kathrin M{\"u}hlemann and Carmen Mu{\~n}oz-Almagro and O'Brien, {Katherine L.} and Murdoch, {David R.} and Park, {Daniel E.} and Puhan, {Milo A.} and Reingold, {Arthur L.} and Raquel Sa-Leao and Abanti Sanyal and Smith, {Peter G.} and Lodewijk Spanjaard and Chonnamet Techasaensiri and Thompson, {Richard E.} and Thoon, {Koh C.} and Tyrrell, {Gregory J.} and Palle Valentiner-Branth and {van der Ende}, Arie and Vanderkooi, {Otto G.} and {van der Linden}, {Mark P.G.} and Emmanuelle Varon and Jan Verhaegen and Vestrheim, {Didrik F.} and Imelda Vickers and {von Gottberg}, Anne and {von Kries}, R{\"u}diger and Pauline Waight and Robert Weatherholtz and Susanne Weiss and Whitney, {Cynthia G.} and Arnold Yee and Zaidi, {Anita K.M.}",

note = "Funding Information: We thank the GAVI Alliance, through AVI-Technical Assistance Consortium, for support of the dosing landscape analysis from which many of the datasets included here were identified. An expert consultation meeting for the study held at WHO in September 2011 was supported by the Bill and Melinda Gates Foundation. We thank the Serotype Replacement Study Group for providing feedback on the analysis at various points and contributing to the paper; the Group co-investigators for collecting and providing the site-specific data; and the Technical Advisory Group (TAG) members for their advice on the study design and data interpretation. ",

year = "2013",

month = sep,

doi = "10.1371/journal.pmed.1001517",

language = "English (US)",

volume = "10",

journal = "PLoS medicine",

issn = "1549-1277",

number = "9",

}

TY - JOUR

T1 - Serotype-Specific Changes in Invasive Pneumococcal Disease after Pneumococcal Conjugate Vaccine Introduction

T2 - A Pooled Analysis of Multiple Surveillance Sites

AU - Feikin, Daniel R.

AU - Kagucia, Eunice W.

AU - Loo, Jennifer D.

AU - Link-Gelles, Ruth

AU - Puhan, Milo A.

AU - Cherian, Thomas

AU - Levine, Orin S.

AU - Whitney, Cynthia G.

AU - O'Brien, Katherine L.

AU - Moore, Matthew R.

AU - Feikin, Daniel R.

AU - Link-Gelles, Ruth

AU - Cherian, Thomas

AU - Adegbola, Richard A.

AU - Agocs, Mary

AU - Ampofo, Krow

AU - Andrews, Nick

AU - Barton, Theresa

AU - Benito, Javier

AU - Broome, Claire V.

AU - Bruce, Michael G.

AU - Bulkow, Lisa R.

AU - Byington, Carrie L.

AU - Camou, Teresa

AU - Cook, Heather

AU - Cotter, Suzanne

AU - Dagan, Ron

AU - de Wals, Philippe

AU - Deceuninck, Geneviève

AU - Denham, Barbara

AU - Edwards, Giles

AU - Eskola, Juhani

AU - Fitzgerald, Margaret

AU - Galanakis, Emmanouil

AU - Garcia-Gabarrot, Gabriela

AU - Garcia-Garcia, Juan J.

AU - Gene, Amadeu

AU - Gomez, Borja

AU - Heffernan, Helen

AU - Hennessy, Thomas W.

AU - Heuberger, Sigrid

AU - Hilty, Markus

AU - Ingels, Helene

AU - Jayasinghe, Sanjay

AU - Kagucia, Eunice W.

AU - Kellner, James D.

AU - Klein, Nicola P.

AU - Kormann-Klement, Andrea

AU - Kozakova, Jana

AU - Krause, Vicki

AU - Kriz, Paula

AU - Lambertsen, Lotte

AU - Lepoutre, Agnès

AU - Levine, Orin S.

AU - Lipsitch, Marc

AU - Loo, Jennifer D.

AU - Lopez-Vega, Mariana

AU - Lovgren, Marguerite

AU - Maraki, Sofia

AU - Mason, Edward O.

AU - McIntyre, Peter B.

AU - Menzies, Robert

AU - Messina, Allison

AU - Miller, Elizabeth

AU - Mintegi, Santiago

AU - Moore, Matthew R.

AU - Motlova, Jitka

AU - Moulton, Lawrence H.

AU - Mühlemann, Kathrin

AU - Muñoz-Almagro, Carmen

AU - O'Brien, Katherine L.

AU - Murdoch, David R.

AU - Park, Daniel E.

AU - Puhan, Milo A.

AU - Reingold, Arthur L.

AU - Sa-Leao, Raquel

AU - Sanyal, Abanti

AU - Smith, Peter G.

AU - Spanjaard, Lodewijk

AU - Techasaensiri, Chonnamet

AU - Thompson, Richard E.

AU - Thoon, Koh C.

AU - Tyrrell, Gregory J.

AU - Valentiner-Branth, Palle

AU - van der Ende, Arie

AU - Vanderkooi, Otto G.

AU - van der Linden, Mark P.G.

AU - Varon, Emmanuelle

AU - Verhaegen, Jan

AU - Vestrheim, Didrik F.

AU - Vickers, Imelda

AU - von Gottberg, Anne

AU - von Kries, Rüdiger

AU - Waight, Pauline

AU - Weatherholtz, Robert

AU - Weiss, Susanne

AU - Whitney, Cynthia G.

AU - Yee, Arnold

AU - Zaidi, Anita K.M.

N1 - Funding Information: We thank the GAVI Alliance, through AVI-Technical Assistance Consortium, for support of the dosing landscape analysis from which many of the datasets included here were identified. An expert consultation meeting for the study held at WHO in September 2011 was supported by the Bill and Melinda Gates Foundation. We thank the Serotype Replacement Study Group for providing feedback on the analysis at various points and contributing to the paper; the Group co-investigators for collecting and providing the site-specific data; and the Technical Advisory Group (TAG) members for their advice on the study design and data interpretation.

PY - 2013/9

Y1 - 2013/9

N2 - Background:Vaccine-serotype (VT) invasive pneumococcal disease (IPD) rates declined substantially following introduction of 7-valent pneumococcal conjugate vaccine (PCV7) into national immunization programs. Increases in non-vaccine-serotype (NVT) IPD rates occurred in some sites, presumably representing serotype replacement. We used a standardized approach to describe serotype-specific IPD changes among multiple sites after PCV7 introduction.Methods and Findings:Of 32 IPD surveillance datasets received, we identified 21 eligible databases with rate data ≥2 years before and ≥1 year after PCV7 introduction. Expected annual rates of IPD absent PCV7 introduction were estimated by extrapolation using either Poisson regression modeling of pre-PCV7 rates or averaging pre-PCV7 rates. To estimate whether changes in rates had occurred following PCV7 introduction, we calculated site specific rate ratios by dividing observed by expected IPD rates for each post-PCV7 year. We calculated summary rate ratios (RRs) using random effects meta-analysis. For children <5 years old, overall IPD decreased by year 1 post-PCV7 (RR 0·55, 95% CI 0·46-0·65) and remained relatively stable through year 7 (RR 0·49, 95% CI 0·35-0·68). Point estimates for VT IPD decreased annually through year 7 (RR 0·03, 95% CI 0·01-0·10), while NVT IPD increased (year 7 RR 2·81, 95% CI 2·12-3·71). Among adults, decreases in overall IPD also occurred but were smaller and more variable by site than among children. At year 7 after introduction, significant reductions were observed (18-49 year-olds [RR 0·52, 95% CI 0·29-0·91], 50-64 year-olds [RR 0·84, 95% CI 0·77-0·93], and ≥65 year-olds [RR 0·74, 95% CI 0·58-0·95]).Conclusions:Consistent and significant decreases in both overall and VT IPD in children occurred quickly and were sustained for 7 years after PCV7 introduction, supporting use of PCVs. Increases in NVT IPD occurred in most sites, with variable magnitude. These findings may not represent the experience in low-income countries or the effects after introduction of higher valency PCVs. High-quality, population-based surveillance of serotype-specific IPD rates is needed to monitor vaccine impact as more countries, including low-income countries, introduce PCVs and as higher valency PCVs are used.Please see later in the article for the Editors' Summary.

AB - Background:Vaccine-serotype (VT) invasive pneumococcal disease (IPD) rates declined substantially following introduction of 7-valent pneumococcal conjugate vaccine (PCV7) into national immunization programs. Increases in non-vaccine-serotype (NVT) IPD rates occurred in some sites, presumably representing serotype replacement. We used a standardized approach to describe serotype-specific IPD changes among multiple sites after PCV7 introduction.Methods and Findings:Of 32 IPD surveillance datasets received, we identified 21 eligible databases with rate data ≥2 years before and ≥1 year after PCV7 introduction. Expected annual rates of IPD absent PCV7 introduction were estimated by extrapolation using either Poisson regression modeling of pre-PCV7 rates or averaging pre-PCV7 rates. To estimate whether changes in rates had occurred following PCV7 introduction, we calculated site specific rate ratios by dividing observed by expected IPD rates for each post-PCV7 year. We calculated summary rate ratios (RRs) using random effects meta-analysis. For children <5 years old, overall IPD decreased by year 1 post-PCV7 (RR 0·55, 95% CI 0·46-0·65) and remained relatively stable through year 7 (RR 0·49, 95% CI 0·35-0·68). Point estimates for VT IPD decreased annually through year 7 (RR 0·03, 95% CI 0·01-0·10), while NVT IPD increased (year 7 RR 2·81, 95% CI 2·12-3·71). Among adults, decreases in overall IPD also occurred but were smaller and more variable by site than among children. At year 7 after introduction, significant reductions were observed (18-49 year-olds [RR 0·52, 95% CI 0·29-0·91], 50-64 year-olds [RR 0·84, 95% CI 0·77-0·93], and ≥65 year-olds [RR 0·74, 95% CI 0·58-0·95]).Conclusions:Consistent and significant decreases in both overall and VT IPD in children occurred quickly and were sustained for 7 years after PCV7 introduction, supporting use of PCVs. Increases in NVT IPD occurred in most sites, with variable magnitude. These findings may not represent the experience in low-income countries or the effects after introduction of higher valency PCVs. High-quality, population-based surveillance of serotype-specific IPD rates is needed to monitor vaccine impact as more countries, including low-income countries, introduce PCVs and as higher valency PCVs are used.Please see later in the article for the Editors' Summary.

UR - http://www.scopus.com/inward/record.url?scp=84884637235&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84884637235&partnerID=8YFLogxK

U2 - 10.1371/journal.pmed.1001517

DO - 10.1371/journal.pmed.1001517

M3 - Article

C2 - 24086113

AN - SCOPUS:84884637235

SN - 1549-1277

VL - 10

JO - PLoS medicine

JF - PLoS medicine

IS - 9

M1 - e1001517

ER -

Serotype-Specific Changes in Invasive Pneumococcal Disease after Pneumococcal Conjugate Vaccine Introduction: A Pooled Analysis of Multiple Surveillance Sites

Abstract

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this